Total knee arthroplasty in young patients with juvenile rheumatoid arthritis.
Parvizi, J., Lajam, C. N., Trousdale, R. T., Shaughnessy, W. J., & Cabanela, M. E. (2003). Journal of Bone and Joint Surgery, 85(6), 1090-1095.
The purpose of the study was to evaluate the clinical and radiographic results associated with the use of a modern design total knee implant in patients with juvenile rheumatoid arthritis who were younger than 20 years old.
All patients under age 20 who had undergone condylar total knee arthroplasty at the authors' institution between 1982 and 1997 were identified. Twenty-seven total knee arthroplasties were performed in 15 patients who were younger than 20 years old at the time of the operation. Two of those patients were excluded because they had a diagnosis of posttraumatic arthritis and osteonecrosis, leaving 25 knees in 13 patients with a diagnosis of juvenile rheumatoid arthritis. The arthritis was polyarticular in six patients, systemic in five, and oligoarticular in two. The patients included 12 males and 1 female and had a mean age of 17 years (range 13 to 19), a mean weight of 53.9 kg (range 34 to 79 kg), and a mean height of 137 cm (range 118 to 173 cm).
This retrospective study, where clinical and radiographic data were reviewed, was restricted to patients who had been managed with a condylar-type prosthesis. Twelve knees had received a cruciate-retaining prosthesis, 2 received a cruciate-sacrificing prosthesis, and 11 had a cruciate-substituting prosthesis. The prostheses had been inserted with cement in 21 knees and without cement in 4 knees. Twenty-one knees had undergone patellar resurfacing with a polyethylene component, 6 knees had inset patellar components, and 15 knees had a resurfacing component. A lateral retinacular release had been performed to facilitate exposure or to enhance patellar tracing in six knees.
The study revealed that total knee arthroplasty provided marked relief of pain, as well as improvements in function and quality of life, for the majority of patients. However, the arthroplasty did not provide a substantial improvement in range of motion and was associated with a high complication rate.
Total knee arthroplasty will continue to be performed for young patients to provide pain relief, deformity reduction, functional status improvement, and quality of life improvement. However, the major role for healthcare providers in patients contemplating knee arthroplasty is to discuss frankly with patients and their families that improvements in range of motion may be minimal and that there is a high risk of complications. Patient education is key.